About the disease
Hypospadias is the most common malformation of urethra in boys. According to different statistics over the last 40 years disease became more common affecting 1 child in every 125-150.
Causes of hypospadias have not been determined yet. Major factors in hypospadias development are environmental disasters, gene mutations, and androgen deputies (not clear, please check this word) which change hormonal status of fetus resulting in penis formation abnormalities. Current disruptors include fungicides, phthalates, pesticides and herbicides, which can cause hypospadias. Development of hypospadias can be caused by hormonal therapy, which a pregnant woman needs to undergo if there is threat of miscarriage. Also if a woman used hormonal contraception, prior to expected pregnancy, a child can also develop hypospadia. If a woman took female hormones to increase fertilization, it can also affect formation of child`s sexual organs. Hereditary factors play an important role in the occurrence of hypospadias. There are cases of children born with hypospadias after several generations.
Often hypospadias is combined with other malformations, such as inguinal hernia, cryptorchidism and hydronephrosis, which is a kidney disease. Therefore, all children with hypospadias need to undergo ultrasound of kidneys and bladder to identify possible comorbidity of urinary system. In the presence of hydronephrosis or vesicoureteral reflux, patient requires correction of upper side of the tract. Patients with proximal forms of hypospadias often require a differentiated approach to the treatment. These children may need to consult with an endocrinologist, geneticist to study the problem in order to avoid formation of further sex pathology.
Types of hypospadias depend on the location of malformation. There is hypospadias of capitatum, when the external opening of urethra is more proximal to the top of penis head. The foreskin is usually displaced. Penis also has a small ventral curvature. Patients with hypospadias of capitatum complain that external opening of the urethra is blocked, stream of urine is very thin and there is change in appearance of the penis.
Patients can also suffer from hypospadias of crown. In this form of hypospadias external opening of urethra is located in the coronal sulcus. Foreskin has the form of "hood". There is also ventral curvature of penis trunk. Complaints include narrowing of hole on the crown. Urine stream is also directed at the wrong angle of penis.
Hypospadias of stem happens if there is an external opening of urethra, which is located at different levels of penis. If penis has a more pronounced curvature, it can be directed downwards. Sometimes patients pull penis to stomach to urinate.
Hypospadias of the scrotal refer to rear forms of hypospadias. There can be a marked ventral curvature of the penis. Urination is possible only in seated position. External genitals resemble large clitoral enlargement. In most cases, boys need to consult with an endocrinologist.
Perineal hypospadias - in this form of hypospadias external opening of the urethra opens on the perineum, the penis is bent sharply, scrotum is split. Boys can urinate only sitting. External genitals have a strange structure.
Symptoms
- External opening of urethra does not open at the top of penis, but becomes displaced proximally in the direction of perineum
- Penis bends sideward to a greater or lesser extent. The degree of curvature is determined at the time of penile erection or during the surgery
- Dysplasia of foreskin - foreskin is split and it is located on top of the penis
Diagnosis
Diagnosis is usually done right after the birth of child, because the deformity of a penis can be seen during first days of child`s life. Sometimes it can even be diagnosed during the last months of pregnancy with ultrasound that can detect slightest deviations in physical form of a baby.
Treatment
The optimal age for hypospadias treatment ranges from 6 to 18 months old. At this age, children have less postoperative complications and they can recover more quickly. Children who were operated before they were 3 years old usually do not remember surgery, which is also a good emotional benefit of early surgery.
- Hypospadias correction. This type of surgery can be classified as reconstructive plastic surgery. During reconstructive surgery doctors eliminate the curvature of corpora cavernosa and recreate missing urethra. Formed urethra grows along with penis as child becomes older.
- Surgical correction of urethral channel. External opening of urethra should be located on top of the penis head and have the normal direction to provide a direct stream of urine, which would have no splashing and no deviation. Doctors also aim to remove all cosmetic defects and to ensure full patient's psychosocial adaptation in society. In some cases boys are advised to visit psychoanalyst which would help them live in society normally.
For the surgical treatment of hypospadias doctors apply modern methods of surgery, using special equipment and microsurgical instruments. They also do everything to minimize rate of postoperative complications and to achieve excellent functional and cosmetic results. Sexual function after surgery for hypospadias is not damaged.
Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko
